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Nutritional Implications of HIV/AIDS
Presented by Sharmaine E. Edwards
Director, Nutrition ServicesMinistry of Health, Jamaica
2006 March 29
Outline Causes and manifestations of
malnutrition in HIV/AIDS
Managing Nutrition and Food-related Problems
Antiretroviral Medications and Food-Drug Interactions
Introduction Nutritional problems are prevalent Complex, multi-factorial etiology Negative impact on immunity &
overall health Decreased quality of life and ability
to perform activities of daily living Increased health care costs
Link Between Malnutrition & HIV/AIDS
Malnutrition
Wasting
Decreased Immunity
Opportunistic Infections
Increased risk of mortality
Increased requirements
Decreased Intake
Increased losses
HIV
Disease progression to AIDS
Malnutrition in HIV/AIDS Starvation
inadequate energy intake or malabsorption adaptation to conserve energy and protein responds to refeeding
Cachexia sepsis, trauma, neoplasm increased metabolic rate and hypercatabolism
of somatic protein treat infection to improve response to feeding
Causes of MalnutritionInadequate Dietary Intake Loss of appetite Gastrointestinal complications
Nausea Early satiety Delayed gastric emptying
Oral/esophageal complications Herpes, Candidiasis, CMV Abnormal taste, dental problems
Eating disorders
Causes of MalnutritionIncreased Nutrient Losses
Diarrhoea Side effect of medications Opportunistic infections HIV enteropathy
Malabsorption Carbohydrates, protein, fats, micronutrients, electrolytes Possible in asymptomatic individuals
Vomiting Opportunistic infections Side effects of medications
Sweats Lose electrolytes and fluids
Causes of MalnutritionIncreased Requirements
Energy Elevated with high viral load, opportunistic
infection and need to gain weight, activity Protein
Elevated for immune cell replication, maintenance of lean body mass, during periods of opportunistic infection
Micronutrients Elevated to treat deficiencies and may have a
role in preventative therapy
Causes of MalnutritionOther Factors Metabolic abnormalities
Drug-food interactions and side effects Nausea, stomach ache, & early satiety Diarrhea, bloating, malabsorption Neuropathy and limited mobility
Co-morbidities
Causes of MalnutritionOther Factors
Special needs groups pregnancy, lactation, childhood
Socioeconomic factors Poverty, homelessness Illicit drug use
Manifestations of MalnutritionWeight Loss
Lose adipose and lean tissue Typical pattern 60% adipose, 40% lean
Acute or rapid weight loss is linked to opportunistic infections
Chronic or slow weight loss is linked to gastrointestinal disease or high viral load
Implications of Weight Loss 3% change = normal variation 5% unintentional loss = risk for
wasting, mortality, opportunistic infections
10% loss = wasting syndrome 20% loss with OI = hospitalization
Manifestations of Malnutrition Wasting Diverse clinical presentation Maladaptive response to reduced
intake Progressive loss of body cell mass Lipoatrophy associated with
lipodystrophy
Wasting due to systemic inflammatory response Neuroendocrine mediation:
catecholamines glucagon, growth hormone, corticosterone mobilize glucose, fatty acids, amino acids
Cytokine production anorexia & semi-starvation decreased muscle protein synthesis increased muscle protein catabolism
HIV-Associated WastingWasting Syndrome
10% weight loss in context of diarrhea/feverProposed definition for HIV-Wasting
>10% loss in 6 months >5% loss in 3 months > 3% loss in 1 month BMI < 20 loss of 5% Body Cell Mass (m) BCM < 35% total weight (BMI <27) (f) BCM < 23% total weight (BMI < 27)
Manifestations of MalnutritionMicronutrient Deficiencies Common, especially in persons with
CD4 < 200 Due to
Inadequate dietary intake Malabsorption Increased turnover Metabolic abnormalities
Associated with increased mortality and faster disease progression
Identify Nutritional Risk
Methods include Nutrition screening Classification of risk by category Subjective global assessment
Need to identify method, who will screen, and referral process
Conclusion Nutritional problems are common
and may be experienced in clusters
The etiology of malnutrition is complex
Nutrition screening identifies individuals in need of more in depth nutritional care